Could It Be Something Other Than Scabies? Skin Nodules

Q: Could It Be Something Other Than Scabies? Skin Nodules

Hello： It is not possible to accurately diagnose skin diseases based solely on a textual description. <br>If your skin abnormalities persist, I recommend seeking a second opinion from a nearby dermatologist. <br>Thank you!

Could it possibly not be scabies?

Hello Doctor: Fourteen days ago, a nodule appeared on my scrotum (initially resembling folliculitis, it felt somewhat hard but was not painful like folliculitis, just mildly itchy.
About 1-2 days later, it turned light red).
The itching was most intense in the past two days, and after it turned light red, it only itched when touched.
After about a week, the first nodule had turned dark brown and appeared crusty.
The day after the first nodule turned dark brown, six more red swollen nodules appeared simultaneously on my scrotum, groin area, and armpit (with similar symptoms).
There were four on the scrotum, one in the groin, and one in the right armpit.
Following the second outbreak of six nodules, I experienced skin itching (around the navel, near the joints of the limbs, and in the armpit).
When I scratched the itchy areas, it left behind a patch of red rash, but as long as I didn't continue scratching, it would subside after a few hours.
Finally, yesterday, I developed a patch of red papules between the webbing of my left index and middle fingers due to itching, so I visited a dermatology clinic today.
The doctor at the clinic took a quick glance at the scrotal nodules and immediately diagnosed it as scabies, prescribing Urea cream and a solution.
After returning home, I applied the Urea cream to the scrotal nodules, and about an hour later, upon re-examination, the originally light red, hard nodules had softened and turned slightly red-brown.
Throughout these 14 days, my skin has not itched while sleeping at night, nor have I been awakened by itching; the itching usually occurs in the morning and does not persist, and I have not developed large patches of red rash.
I feel that the symptoms differ somewhat from those of scabies, and I have read that if the nodules were caused by scabies, the swelling would not subside so quickly after applying the cream.
Additionally, I mainly work from home, and my outings are limited to nearby convenience stores; I rarely come into contact with others in public places.
I recall dining in a crowded restaurant in January.
Lastly, I would like to ask: Is it possible that this is not scabies? Thank you, Dr.
Lee.

Mr. X, 20~29 year old female. Ask Date: 2019/03/25

Dr. Li Yufen reply Dermatology

Hello: It is not possible to accurately diagnose skin diseases based solely on a textual description.
If your skin abnormalities persist, I recommend seeking a second opinion from a nearby dermatologist.
Thank you!

Reply Date: 2019/03/25

More Info

Based on the symptoms you've described, it is indeed possible that your skin issues are not solely due to scabies. Scabies typically presents with intense itching, especially at night, and is often accompanied by a rash or burrows in the skin. However, the characteristics of your nodules, their progression, and the fact that they have changed color and texture after applying medication suggest that there may be other dermatological conditions at play.

The initial appearance of a firm, itchy nodule that later became red and then darkened could indicate several possibilities, including folliculitis, a benign cyst, or even a dermatological condition such as a seborrheic keratosis or a dermatofibroma. The fact that you have developed multiple nodules in different areas, including the groin and armpits, raises the possibility of a more systemic condition or an allergic reaction, rather than a localized infestation like scabies.

When it comes to skin nodules, it is essential to consider factors such as your personal and family medical history, recent changes in your environment, and any new products you may have used on your skin. For instance, if you have recently changed soaps, detergents, or lotions, these could potentially cause allergic reactions leading to the symptoms you are experiencing. Additionally, stress and changes in climate can also affect skin health, leading to conditions like eczema or contact dermatitis.

Regarding the treatment you received, while the topical medication prescribed for scabies (like permethrin) can be effective, the rapid improvement you noticed might suggest that your condition was not scabies to begin with. If the nodules have softened and the redness has decreased, it could indicate that your skin is responding to the treatment, but it is crucial to monitor the situation closely.

If the nodules persist, change in appearance, or if you develop new symptoms, it would be wise to seek a second opinion from a dermatologist. They may recommend a skin biopsy or other diagnostic tests to determine the exact nature of your skin condition. This is particularly important if you notice any signs of infection, such as increased redness, warmth, swelling, or discharge from the nodules.

In terms of prevention, maintaining good skin hygiene, using hypoallergenic products, and avoiding known irritants can help reduce the risk of developing similar skin issues in the future. Additionally, keeping your skin moisturized and avoiding excessive scratching can prevent further irritation and potential secondary infections.

In conclusion, while scabies is a possibility, your symptoms and their progression suggest that there may be other underlying conditions. It is essential to continue monitoring your skin and consult with a healthcare professional for a thorough evaluation and appropriate management.

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